The history of autism
Abstract Autism remains a fascinating condition, perhaps the most prolifically researched of all child psychiatric disorders. Its history yields many lessons: early accounts of possible autism are, with one exception, unclear; the greatest contributions to our understanding have come from individual clinicians and researchers; the concept and definition of the disorder have changed greatly over the years; some ideas once held with conviction, were later proved to be unfounded; and socio-political shifts as well as research findings have radically altered our understanding of the syndrome as well as the care and treatment offered to people with autism.

Changes in the concept and definition of the disorder over the years

Kanner defined autism narrowly and was dismayed by its widening “almost over night” to include children with isolated autistic symptoms on the basis of brain damage and mental retardation. Suddenly, in the 1950s, “the country was populated by a multitude of autistic children”. Moreover, in the 1950s and 1960s, especially in the US,schizophrenia was everywhere and in children it included autism . Schizophrenia was often held to be psychogenic and the psychoanalytic theories which then prevailed, often led to wasted and painful years of expensive psychotherapy for affected children and their parents.

As a result of Rutter’s and Kolvin’s studies in the 1960s and 1970s,the concept was again restricted only to widen once more in the 1980s.

This wider concept took off from Wing and Gould’s epidemiological study which was based on children with special educational needs and included many with brain syndromes and learning disabilities. From a therapeutic stand point, this was helpful because when such children have autistic features,they benefit from exactly the same educational and therapeutic methods as other children with autism. It was also helpful that the US Developmental Disability Act of 1975 included them along with other people with severe and chronic developmental disabilities and mental retardation,because of the similarities of their administrative needs for financial support and for special educational services.

In addition, Wing’s rediscovery of Asperger’s work   drew attention to high functioning autism with which Asperger syndrome, as currently defined, is often equated , and this culminated in the birth of the autistic spectrum which has been useful both clinically and as a basis for genetic and other studies.

More debatable is the widening of the concept to include exceptionally gifted people with Asperger syndrome, such as philosophers and mathematicians, for example, Wittgenstein and the Nobel prize winner, John Nash prior to his schizophrenic illness whose therapeutic needs, if any, are very different.

###

Sula Wolff  FRCP, FRCPsych (
)
38 Blacket Place
Edinburgh EH9 1RL, UK

The Early Origins of Autism
Autism has been mystifying scientists for more than half a century. The complex behavioral disorder encompasses a wide variety of symptoms, most of which usually appear before a child turns three. Children with autism are unable to interpret the emotional states of others, failing to recognize anger, sorrow or manipulative intent. Their language skills are often limited, and they find it difficult to initiate or sustain conversations. They also frequently exhibit an intense preoccupation with a single subject, activity or gesture.

These behaviors can be incredibly debilitating. How can you be included in a typical classroom if you can’t be dissuaded from banging your head on your desk? How can you make friends if your overriding interest is in calendars? When children with autism also suffer from mental retardation - as most of them do - the prognosis is even worse. Intensive behavioral therapy improves the outcome for many patients, but their symptoms can make it impossible for them to live independently, even if they have normal IQs.

I became involved in the search for autism’s causes relatively recently - and almost by accident. As an embryologist, I previously focused on various birth defects of the brain. In 1994 I attended a remarkable presentation at a scientific conference on research into birth defects.

Two pediatric ophthalmologists, Marilyn T. Miller of the University of Illinois at Chicago and Kerstin Stromland of Goteborg University in Sweden, described a surprising outcome from a study investigating eye motility problems in victims of thalidomide, the morning-sickness drug that caused an epidemic of birth defects in the 1960s. The study’s subjects were adults who had been exposed to the drug while still in the womb. After examining these people, Miller and Stromland made an observation that had somehow eluded previous researchers: about five percent of the thalidomide victims had autism, which is about 30 times higher than the rate among the general population.

When I heard these results, I felt a shock of recognition, a feeling so powerful that I actually became dizzy and began to hyperventilate. In the effort to identify autism’s causes, researchers had long sought to pinpoint exactly when the disorder begins. Previous speculation had focused on late gestation or early postnatal life as the time of origin, but there was no evidence to back up either hypothesis. The connection with thalidomide suddenly threw a brilliant new light on the subject. It suggested that autism originates in the early weeks of pregnancy, when the embryo’s brain and the rest of its nervous system are just beginning to develop. Indeed, Miller and Stromland’s work convinced me that the mystery of autism could soon be solved.

###

by Patricia M. Rodier
Scientific American